What is Gestational Diabetes?
A pregnant woman is unable to maintain normal fasting blood sugar levels and also blood sugar levels after glucose challenge test. Interestingly blood sugar levels comes to normal levels after the baby was born. So it is short lived condition. It generally developed in second half of pregnancy.
* Positive family history of diabetes
* Unexplained still birth
* Polyhydromnios (excess amniotic fluid)
Reason Of Gestational Diabetes:
Normally insulin secreted by the pancreas controls blood sugar by pushing the excess glucose in to cells. But in pregnancy placenta produces hormones (human placental lactogen, placental insulinase, cortisol, progesterone) that counteract the actions of insulin. They increase blood glucose and make tissue resistant to insulin action. Once baby was born and placenta was delivered, these hormones action wanes out with in few days and blood glucose comes to normal.
Diagnose Gestational Diabetes:
Screening for gestational diabetes is routinely done on all pregnant woman as a part of regular checkups. If the pregnant woman has risk factors, early testing is required.
First screening test will be done : by 1 hour – 50 gram – oral glucose tolerance test. If the pregnant woman has blood glucose less than 140 mg/dl, it is considered normal. If the values are more than that then pregnant woman needs another test to confirm the diagnosis : 3 hour – 100 gram – oral glucose tolerance test.For this test patient need to be on overnight fasting. And three glucose values are obtained after the test. So total four values – one fasting and three after intake of glucose. If any two of four values are abnormal, then it is diagnostic of gestational diabetes.
For the baby -
* Low blood sugar because of persistent insulin in baby’s blood
* Large babies due to excess growth result to excess insulin
* Low calcium levels in baby
* Jaundice due to liver immaturity
* Respiratory problems due to delayed lung maturation
For the mother -
* Big babies and difficult delivery
* Loss of blood after delivery due to uterine agony
Management Of Gestation Diabetes:
It is necessary to do home glucose monitoring at least four times a day. Also in some patients insulin therapy is required where they have to be given an extra dose of insulin. Diet of pregnant woman should be rich in whole grains, vegetables, low fats and nutritious. Regular exercise under the doctors guidance is a must like moderate aerobic exercises, walking, cycling are advised.
Women with overt diabetes have increased risk of fetal anomalies. These can be reduced by maintaining normal blood glucose levels starting three months prior to discontinuing the oral contraceptives or planning to conceive. Also Folic acid supplementation should started three months prior to conception.
[tags]diabetes, diabetic, diabetic pregnancy, gestational diabetes[/tags]